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General NPI Number Information
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NPI Number | 1174932693
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Entity Type | Organization
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Legal Business Name | TEXAS CLINICS NETWORK INC
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Dates
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Enumeration Date | 08/08/2014
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Last Update Date | 08/08/2014
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Provider Practice Location Address
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Address Line | 5930 BELLAIRE BLVD SUITE C
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City | HOUSTON
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State | TX
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Zip | 77081-5502
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Country | US
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Telephone | 713-660-6400
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Fax | 713-660-6401
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Provider Business Mailing Address
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Address Line | 5930 BELLAIRE BLVD SUITE C
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City | HOUSTON
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State | TX
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Zip | 77081-5502
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Country | US
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Telephone | 713-660-6400
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Fax | 713-660-6401
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. STANTON C PACKARD
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Credential | M.D.
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Telephone | 713-660-6400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | J6641
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License Number State | TX
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